Provider Demographics
NPI:1215907415
Name:REICHERT, DANIEL ROBERT (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:REICHERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE # 54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25455 BARTON RD STE 206A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3130
Practice Address - Country:US
Practice Address - Phone:909-558-6600
Practice Address - Fax:909-558-6997
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG143685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215907415OtherNPI
MI1902086689OtherGROUP NPI
MIP17270003OtherMEDICARE INDIVIDUAL PTAN
MI4415925Medicaid
MIG07209Medicare UPIN
MI700A146860OtherBCBSM GROUP PIN